Psychiatric Comorbidity in Epilepsy: A Population-Based Analysis.

Posted on August 1, 2007 by Maurice Preter MD
Epilepsia. 2007 Jul 28; [Epub ahead of print] Related Articles, Links
Psychiatric Comorbidity in Epilepsy: A Population-Based Analysis.

Tellez-Zenteno JF, Patten SB, Jetté N, Williams J, Wiebe S.

Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Purpose: The estimated prevalence of mental health disorders in those with epilepsy in the general population varies owing to differences in study methods and heterogeneity of epilepsy syndromes. We assessed the population-based prevalence of various psychiatric conditions associated with epilepsy using a large Canadian national population health survey. Methods: The Canadian Community Health Survey (CCHS 1.2) was used to explore numerous aspects of mental health in persons with epilepsy in the community compared with those without epilepsy. The CCHS includes administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Age-specific prevalence of mental health conditions in epilepsy was assessed using logistic regression. Results: The prevalence of epilepsy was 0.6%. Individuals with epilepsy were more likely than individuals without epilepsy to report lifetime anxiety disorders or suicidal thoughts with odds ratio of 2.4 (95% CI = 1.5-3.8) and 2.2 (1.4-3.3), respectively. In the crude analysis, the odds of lifetime major depression or panic disorder/agoraphobia were not greater in those with epilepsy than those without epilepsy, but the association with lifetime major depression became significant after adjustment for covariates. Conclusions: In the community, epilepsy is associated with an increased prevalence of mental health disorders compared with the general population. Epilepsy is also associated with a higher prevalence of suicidal ideation. Understanding the psychiatric correlates of epilepsy is important to adequately manage this patient population.

PMID: 17662062 [PubMed – as supplied by publisher]

Posted in Psychiatry/Neurology |

Group psychotherapy also significantly improved ED compared to sildenafil citrate alone.

Posted on July 27, 2007 by Maurice Preter MD
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004825. Related Articles, Links
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Psychosocial interventions for erectile dysfunction.

Melnik T, Soares B, Nasselo A.

BACKGROUND: Normal sexual function is a biopsychosocial process and relies on the coordination of psychological, endocrine, vascular, and neurological factors. Recent data show that psychological factors are involved in a substantial number of cases of erectile dysfunction (ED) alone or in combination with organic causes. However, in contrast to the advances in somatic research of erectile dysfunction, scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED. OBJECTIVES: To evaluate the effectiveness of psychosocial interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices and other psychosocial interventions, that may include any psycho-educative methods and psychotherapy, or both, of any kind. SEARCH STRATEGY: The following databases were searched to identify randomised or quasi-randomised controlled trials: MEDLINE (1966 to 2007), EMBASE (1980 to 2007), psycINFO (1974 to 2007), LILACS (1980 to 2007), DISSERTATION ABSTRACTS (2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2007). Besides this electronic search cross checking the references of all identified trials, contact with the first author of all included trials was performed in order to obtain data on other published or unpublished trials. Handsearch of the International Journal of Impotence Research and Journal of Sex and Marital Therapy since its first issue and contact with scientific societies for ED completed the search strategy. SELECTION CRITERIA: All relevant randomised and quasi-randomised controlled trials evaluating psychosocial interventions for ED. DATA COLLECTION AND ANALYSIS: Authors of the review independently selected trials found with the search strategy, extracted data, assessed trial quality, and analysed results. For categorical outcomes the pooled relative risks (RR) were calculated, and for continuous outcomes mean differences between interventions were calculated as well. Statistical heterogeneity was addressed. MAIN RESULTS: Nine randomised (Banner 2000; Baum 2000; Goldman 1990; Kilmann 1987; Kockott 1975; Melnik 2005; Munjack 1984; Price 1981; Wylie 2003) and two quasi-randomised trials (Ansari 1976; Van Der Windt 2002), involving 398 men with ED (141 in psychotherapy group, 109 received medication, 68 psychotherapy plus medication, 20 vacuum devices and 59 control group) met the inclusion criteria. In data pooled from five randomised trials (Kockott 1975; Ansari 1976; Price 1981; Munjack 1984; Kilmann 1987), group psychotherapy was more likely than the control group (waiting list – a group of participants who did not receive any active intervention) to reduce the number of men with “persistence of erectile dysfunction” at post-treatment (RR 0.40, 95% CI 0.17 to 0.98, N = 100; NNT 1.61, 95% CI 0.97 to 4.76).At six months follow up there was continued maintenance of reduction of men with “persistence of ED” in favour of group psychotherapy (RR 0.43, 95% CI 0.26 to 0.72, N = 37; NNT 1.58, 95% CI 1.17 to 2.43).In data pooled from two randomised trials (Price 1981; Kilmann 1987), sex-group psychotherapy reduced the number of men with “persistence of erectile dysfunction” in post-treatment (RR 0.13, 95% CI 0.04 to 0.43, N = 37), with a 95% response rate for sex therapy and 0% for the control group (waiting list – no treatment) (NNT 1.07, 95% CI 0.86 to 1.44).Treatment response appeared to vary between patient subgroups, although there was no significant difference in improvement in erectile function according to mean group age, type of relationship, and severity of ED. In two trials (Melnik 2005; Banner 2000) that compared group therapy plus sildenafil citrate versus sildenafil, men randomised to receive group therapy plus sildenafil showed significant reduction of “persistence of ED” (RR 0.46, 95% CI 0.24 to 0.88; NNT 3.57, 95% CI 2 to 16.7, N = 71), and were less likely than those receiving only sildenafil to drop out (RR 0.29, 95% CI 0.09 to 0.93).One small trial (Melnik 2005) directly compared group therapy and sildenafil citrate. It found a significant difference favouring group therapy versus sildenafil in the mean difference of the IIEF (WMD -12.40, 95% CI -20.81 to -3.99, N = 20).No differences in effectiveness were found between psychosocial interventions versus local injection and vacuum devices. AUTHORS’ CONCLUSIONS: There was evidence that group psychotherapy may improve erectile function. Treatment response varied between patient subgroups, but focused sex-group therapy showed greater efficacy than control group (no treatment). In a meta-analysis that compared group therapy plus sildenafil citrate versus sildenafil, men randomised to receive group therapy plus sildenafil showed significant improvement of successful intercourse, and were less likely than those receiving only sildenafil to drop out. Group psychotherapy also significantly improved ED compared to sildenafil citrate alone. Regarding the effectiveness of psychosocial interventions for the treatment of ED compared to local injection, vacuum devices and other psychosocial techniques, no differences were found.

PMID: 17636774 [PubMed – in process]

Posted in Psychiatry/Neurology |

Adenosine as a non-opioid analgesic in the perioperative setting.

Posted on July 26, 2007 by Maurice Preter MD
Anesth Analg. 2007 Aug;105(2):487-94. Related Articles
Adenosine as a non-opioid analgesic in the perioperative setting.

Gan TJ, Habib AS.

Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. GAN00001@mc.duke.edu

Adenosine, a ubiquitous metabolic intermediate in the body, is involved in nearly every aspect of cell function, including neuromodulation and neurotransmission. Adenosine A(1) and A(2) receptors are widely distributed in the brain and spinal cord, and are a novel, non-opiate target for pain management. The potential of adenosine as a non-narcotic analgesic in anesthetized patients has been explored in clinical trials, including double-blind studies versus placebo and remifentanil infusion. These studies suggest that, compared to placebo or remifentanil, an intraoperative adenosine infusion stabilizes core hemodynamics and reduces the requirement for anesthesia during surgery. Further, adenosine improves postoperative recovery, as indicated by lower pain scores and less opioid consumption. The safety profile of adenosine has been well characterized based on use of currently approved adenosine products. The most common adverse events associated with its use include flushing, chest discomfort, dyspnea, headache, gastrointestinal discomfort, and lightheadedness. These effects are generally well tolerated and transient. Further studies are warranted to investigate the full potential of adenosine as a non-opioid analgesic in the perioperative setting.

Publication Types:

PMID: 17646510 [PubMed – in process]

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Abdominal Adiposity Has Adverse Effects, Regardless of BMI

Posted on July 19, 2007 by Maurice Preter MD

Abdominal Adiposity Has Adverse Effects, Regardless of BMI

With fat distribution, it’s location, location, location.

In general, evidence implicates body-fat distribution as a risk factor for morbidity and mortality. To evaluate the link between abdominal adiposity and premature death in lean populations, trained interviewers measured baseline weight, height, and waist and hip circumferences (according to a standard protocol) for more than 72,000 nonsmoking participants in the Shanghai Women’s Health Study, a population-based, prospective cohort study (age range, 40–70). Mortality data were verified via registries and death certificates. Mean age at enrollment was 52. Mean BMI was normal (24 kg/m2); 35.2% were overweight or obese (BMI >=25), and 5% were obese (BMI >=30). Mean waist-hip ratio (WHR) was 0.81.

During a mean follow-up of 5.7 years, 1456 women died. WHR was positively associated, in dose-response fashion, with all-cause, cardiovascular, stroke, and diabetes mortality (P<0.01 for trend). After adjusting for BMI and other possible confounders, women in the highest WHR quintile had higher risks for death from all causes (relative risk, 1.79), cardiovascular disease (RR, 2.41), and stroke (RR, 2.23) compared with those in the lowest quintile. When stratified for BMI, women with lower BMIs had an even greater risk for death with increasing WHR.

Comment: In less than 6 years, WHR predicted higher mortality in this lean (compared with U.S. women) Chinese population. But an editorialist cautions that, because of time constraints, lack of standardization, and questions about whether abdominal obesity increases risk for all or some populations, fat-distribution measurement in clinical practice is unlikely to become part of routine clinical practice any time soon. What we can do is explain to our patients that BMI is not the whole story. Women with normal BMI but increased abdominal girth can be advised to exercise (which has been shown to decrease waist circumference [Journal Watch Women’s Health Jun 21 2007] and to improve on other modifiable risk factors.

— Diane E. Judge, APN/CNP

Published in Journal Watch Women’s Health June 21, 2007

Citations

Zhang X et al. Abdominal adiposity and mortality in Chinese women. Arch Intern Med 2007 May 14; 167:886-92. [Medline® abstract]

Hu FB. Obesity and mortality: Watch your waist, not just your weight. Arch Intern Med 2007 May 14; 167:875-6. [Medline® abstract]

Copyright © 2007. Massachusetts Medical Society. All rights reserved.

The above message comes from “Journal Watch“, who is solely responsible for its content.

Posted in Psychiatry/Neurology |

US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study h

Posted on July 17, 2007 by Maurice Preter MD
 
May 9, 2007 — US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study has shown.

Furthermore, based on the age and sex of the study cohort, which was predominantly male, investigators found there was a 2-fold increased prevalence of migraine among these veterans compared with the general population.

“These findings indicate soldiers with migraine are more likely to have symptoms of psychiatric conditions after a combat tour, with depression and PTSD being the most prevalent,” said the study’s principal investigator, Maj. Jay C. Erickson, MD, PhD, from the Madigan Army Medical Center, in Tacoma, Washington.

“This is the first study to examine the co-occurrence of migraines and psychiatric conditions in a military population. In addition, we think it may be the first study in any population to establish a possible link between migraine and PTSD,” he added.

The study was presented at American Academy of Neurology 59th Annual Meeting, in Boston, Massachusetts.

Migraine Prevalence 2-Fold Higher In Veterans

The cross-sectional study involved 3621 US soldiers who were asked to complete a voluntary migraine headache questionnaire based on International Headache Society criteria within 90 days of returning from a 1-year combat tour in Iraq. This screening instrument assessed headache frequency, severity, and duration in the last 3 months of deployment.

In addition, soldiers were asked to complete the Patient Health Questionnaire to screen for depression and anxiety and the Primary Care PTSD Screen to determine symptoms of PTSD.

In all, 2167 soldiers (60%) completed the questionnaire. Of the total study group, 19% screened positive for migraine, 32% screened positive for depression, 22% screened positive for PTSD, and 13% had anxiety. The average age of participants was 27 years and 96% were male.

Dr. Erickson pointed out that if this study had been conducted in an age- and sex-matched general population, the expected prevalence of migraine would be about 10%.

“What we have seen [in this study] is migraine prevalence that is 2-fold higher than you would expect in a general population based on age and gender,” he said.

When investigators compared the screening prevalence of each psychiatric condition in soldiers with migraine with nonmigraineurs they found individuals who screened positive for migraine were much more likely to have 1 or more psychiatric disorders. Overall, said Dr. Erickson, symptoms of 1 or more psychiatric conditions were present in 58% of soldiers with migraine vs 34% without migraine.

Prevalence of Psychiatric Disorders Among US Soldiers With Migraine vs Soldiers Without Migraine

Psychiatric Disorder
US Soldiers With Migraine (%)
US Soldiers Without Migraine (%)
Depression
50
27
PTSD
39
18
Anxiety
17
7
Migraine Indicator for Mental Health Screening

The study also found individuals with migraine and depression had more frequent headaches than those with migraine and no depression — an average of 3.5 headache days per month vs 2.5 days per month, respectively. The findings were similar for those with migraine and PTSD.

In contrast, said Dr. Erickson, anxiety did not affect headache frequency in subjects with migraine. In addition, neither pain severity or duration of migraines was significantly different among soldiers with and without symptoms of any of the study’s psychiatric conditions.

“These findings indicate that soldiers with migraine headaches are more likely to have certain psychiatric conditions following combat deployment. This knowledge should assist in the early diagnosis and treatment of soldiers with these health problems,” said Dr. Erickson.

He added that healthcare providers evaluating soldiers with migraine headaches should also perform mental health screening to ensure comorbid psychiatric disorders are identified and properly treated in this high-risk population.

Potential Shared Mechanism

At this point, the link between migraine and psychiatric disorders is not well understood. However, said Dr. Erickson, 1 possible shared biological mechanism may be altered signaling in the serotonin system as well as the norepinephrine system, both of which have been associated with migraine and the psychiatric disorders included in the study.

“Additional studies are needed to better understand the relationship between migraines and psychiatric conditions in military members. A better understanding of the shared mechanism could lead to improved prevention and treatment for migraines and psychiatric conditions in deployed military personnel,” he said.

American Academy of Neurology 59th Annual Meeting: Abstract P06.035. April 28 – May 5, 2007.

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